Intersectionality and Inequalities in Medical Risk for Severe COVID-19 in the Canadian Longitudinal Study on Aging.

Abstract

Background and ObjectivesOlder populations with underlying medical conditions are at higher risk of COVID-19 severity and mortality once infected. Intersectional gerontology considers the compounding effects of multiple forms of social inequity. This study explores how racial-nativity status, family income, education level and the intersecting profile of these three social standings stratify differential patterns of chronic conditions among Canadians aged 45 years and older.Research Design and MethodsUsing the baseline Canadian Longitudinal Study on Aging (n = 29,748), multinomial logistic regression analyses were conducted to estimate multivariable-adjusted odds of having one and/or two (≤ 2) or multiple (≥3) medical conditions (i.e., diabetes, asthma, cancer, previous heart attack, cardiovascular disease, kidney disease, hypertension, chronic obstructive pulmonary disease, and obesity) based on socio-demographic characteristics.ResultsThere were significant racial-nativity disparities and social-class gradients in multimorbidity. The odds of having ≥3 medical conditions were greater for Black immigrants (OR=1.79, 95% CI=1.13, 2.82), South Asian immigrants (OR=1.49, 95% CI=1.02, 2.19) and close to double for Aboriginal Canadians (OR=1.96, 95% CI=1.37, 2.80) relative to Canadian-born Whites. Black, South Asian and Aboriginal populations from disadvantaged socioeconomic backgrounds had the highest odds of having ≥3 medical conditions (OR=3.50, 95% CI=1.41, 8.70).Discussion and ImplicationsDespite a universal health system, marginalized older Canadians who are racialized foreign-born, less educated, and/or low-income have a higher prevalence of multimorbidity that are associated with COVID-19 severe illness and mortality. Upstream health policy and social care tackling intersecting structural inequities should be undertaken to prevent increasing multimorbidity among underserved aging populations.